Blood-brain barrier disruption and neuroinflammation in the hippocampus of a cardiac arrest porcine model: Single-cell RNA sequencing analysis

JOURNAL/nrgr/04.03/01300535-202602000-00043/figure1/v/2025-05-05T160104Z/r/image-tiff Global brain ischemia and neurological deficit are consequences of cardiac arrest that lead to high mortality. Despite advancements in resuscitation science, our limited understanding of the cellular and molecular mechanisms underlying post-cardiac arrest brain injury have hindered the development of effective neuroprotective strategies. Previous studies primarily focused on neuronal death, potentially overlooking the contributions of non-neuronal cells and intercellular communication to the pathophysiology of cardiac arrest-induced brain injury. To address these gaps, we hypothesized that single-cell transcriptomic analysis could uncover previously unidentified cellular subpopulations, altered cell communication networks, and novel molecular mechanisms involved in post-cardiac arrest brain injury. In this study, we performed a single-cell transcriptomic analysis of the hippocampus from pigs with ventricular fibrillation-induced cardiac arrest at 6 and 24 hours following the return of spontaneous circulation, and from sham control pigs. Sequencing results revealed changes in the proportions of different cell types, suggesting post-arrest disruption in the blood-brain barrier and infiltration of neutrophils. These results were validated through western blotting, quantitative reverse transcription-polymerase chain reaction, and immunofluorescence staining. We also identified and validated a unique subcluster of activated microglia with high expression of S100A8, which increased over time following cardiac arrest. This subcluster simultaneously exhibited significant M1/M2 polarization and expressed key functional genes related to chemokines and interleukins. Additionally, we revealed the post-cardiac arrest dysfunction of oligodendrocytes and the differentiation of oligodendrocyte precursor cells into oligodendrocytes. Cell communication analysis identified enhanced post-cardiac arrest communication between neutrophils and microglia that was mediated by neutrophil-derived resistin, driving pro-inflammatory microglial polarization. Our findings provide a comprehensive single-cell map of the post-cardiac arrest hippocampus, offering potential novel targets for neuroprotection and repair following cardiac arrest.

Beyond the infection: mapping the risk of cardiovascular events post-scrub typhus in a nationwide cohort study

ABSTRACTScrub typhus, caused by Orientia tsutsugamushi, often involves multiple organs, but its cardiovascular (CV) sequelae in survivors remain under-researched. This retrospective cohort study analyzed data from the National Health Insurance Research Database (NHIRD) spanning 2010-2015 to assess CV risks among scrub typhus survivors. Excluding those with prior CV events, we focused on outcomes such as acute myocardial infarction (AMI), heart failure hospitalization (HFH), strokes, new-onset atrial fibrillation (AF), aortic aneurysm or dissection, venous thromboembolism (VTE), and CV death. From 2,269 scrub typhus patients without previous CV events (mean age 47.8 ± 16.1; 38.0% female), and a matched control group (n = 2,264), we observed a higher incidence of HFH, new-onset AF, and total CV events in the scrub typhus cohort. Adjusted hazard ratios (aHRs) were 1.97 (95% CI: 1.13-3.42) for HFH, 2.48 (95% CI: 1.23-5.0) for new-onset AF, and 1.43 (95% CI: 1.08-1.91) for total CV events. Other outcomes did not significantly differ. Scrub typhus survivors exhibit an increased risk of CV events, particularly HFH and new-onset AF, underscoring the importance of heightened physician awareness and post-infection cardiac surveillance.

Visual determination of heparin in serum utilizing surfen-induced aggregation emission enhancement of gold nanoclusters and heparin-induced fluorescence enhancement of surfen

We developed a ratiometric luminescence probe for heparin detection based on the interactions among surfen, glutathione-capped gold nanoclusters (GSH-AuNCs), and heparin. At neutral pH, surfen triggers aggregation-induced emission enhancement (AIEE) in GSH-AuNCs, forming dual-emission surfen-AuNC aggregates with fluorescence at 490 nm and 610 nm. Heparin competitively binds to surfen, displacing it from the aggregates, resulting in decreased fluorescence at 610 nm and increased emission at 490 nm, enabling both ratiometric and visual heparin detection. Investigations of the AIEE mechanism reveal that surfen reduces electrostatic repulsion and enhances van der Waals interactions, facilitating nanocluster aggregation. Theoretical models based on the Derjaguin-Landau-Verwey-Overbeek (DLVO) theory were employed to quantify these interactions. The probe demonstrates a linear response for heparin concentrations between 0.5 and 10 μM, with a detection limit of 0.2 μM, suitable for clinical monitoring. In 10-fold diluted human plasma, the probe maintains sensitivity, allowing naked eye detection of heparin through distinct color changes. These findings highlight this ratiometric probe as a practical, sensitive, and accessible tool for heparin quantification in complex clinical samples, surpassing the limitations of single-emission probes.

Are current scales adequate for assessing quality of life after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy?

Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are complex surgical procedures that are often used to treat advanced cancers of the abdominal cavity with peritoneal metastasis. Although these treatments can be lifesaving, patients often experience a significant decrease in their overall quality of life (QoL), especially in the early stages of recovery, owing to the physical burden of surgery and the effects of chemotherapy. Many traditional QoL questionnaires have been used to measure CRS and HIPEC. However, these classical current QoL assessment tools often fail to capture the unique challenges faced by this population, including bowel dysfunction, stoma-related distress, and long-term survivorship issues. Therefore, additional parameters that assess bowel function and stoma opening status and especially patient-reported outcome measures would be useful in QoL measurements to provide a more detailed understanding of recovery and general well-being in these patients.

Innovative approaches to managing chronic multimorbidity: A multidisciplinary perspective

The rising prevalence of chronic multimorbidity poses substantial challenges to healthcare systems, necessitating the development of innovative management strategies to optimize patient care and system efficiency. The study by Fontalba-Navas et al investigates the implementation of a novel high complexity unit (HCU) specifically designed to improve the management of patients with chronic complex conditions. By adopting a multidisciplinary approach, the HCU aims to provide comprehensive, patient-centered care that enhances health outcomes and alleviates the strain on traditional hospital services. Utilizing a longitudinal analysis of data from the Basic Minimum Data Set, this study compares hospitalization metrics among the HCU, Internal Medicine, and other departments within a regional hospital throughout 2022. The findings reveal that the HCU's integrated care model significantly reduces readmission rates and boosts patient satisfaction compared to conventional care practices. The study highlights the HCU's potential as a replicable model for managing chronic multimorbidity, emphasizing its effectiveness in minimizing unnecessary hospitalizations and enhancing the overall quality of patient care. This innovative approach not only addresses the complexities associated with chronic multimorbid conditions but also offers a sustainable framework for healthcare systems confronting similar challenges.

In-silico assessment of longer measurement intervals in glycaemic control to match clinical practice

BACKGROUND AND OBJECTIVE

STAR is a patient-specific glycaemic control (GC) framework accounting for both inter- and intra- patient variability to modulate insulin and nutrition in ICU patients. While providing safe, effective control to all patient, the workload induced by STAR represents a clinical burden in some ICUs. This study aims at extending the treatment interval of STAR from 1-3 hourly to 1-6 hourly to reduce the workload associated with STAR and assessing the impact on GC outcomes using virtual trials.

METHODS

Retrospective data form 606 patients are used to create virtual patients. Insulin sensitivity is identified for each patient using a physiological model and used to build and validate the new stochastic models to provide up to 6-hourly predictions using five-fold cross-validation. Virtual trials are performed and safety, performance, nutrition intake and workload are compared and analysed.

RESULTS

The extended STAR protocol 1-6 hourly measurement interval still provided high control safety and efficacy. Results showed slightly reduced %BG within the safe target band 4.4-8.0 mmol/L (from 83.8 to 81.4 %) as the measurement interval increased. It also resulted in an increased risk of hyper- (from 14.5 to 16.9 %BG > 8.0 mmol/L) and severe hypo- (from 0.03 to 0.05 %BG < 2.2 mmol/L) glycaemia. Insulin and nutrition rates decreased (from 3.5 [2.0 5.0] to 2.5 [1.7 3.0] U/h and from 100 [85 100] to 89 [71 100] % goal feed (GF) respectively). The workload was significantly reduced from 12 to 8 measurements per day.

CONCLUSIONS

The workload was successfully reduced by extending the measurement interval, approaching clinical practice. High performance and safety are achieved. However, the results also highlight a clear risk and reward trade-off in glycaemic control with the increased risk of hyper- and hypo- glycaemia and the reduced nutrition rates. Choosing an intermediate measurement interval could be an interesting solution. Clinical trials should be conducted to further confirm those results and consider the adoption of longer treatment intervals in STAR GC framework.

Sepsis Epidemiology, Definitions, Scoring Systems, and Diagnostic Markers

Sepsis is a life-threatening organ dysfunction resulting from a dysregulated host response to infection. It is a major global health concern due to its high morbidity and mortality. This article provides a comprehensive overview of sepsis, focusing on its epidemiology, definitions, scoring systems, and diagnostic markers. The epidemiology section highlights the global burden of sepsis, noting variations in incidence and mortality across different regions and populations. It also discusses the risk factors associated with sepsis, including age, comorbidities, and healthcare-associated exposures. The definitions section traces the evolution of sepsis definitions, emphasizing the current sepsis-3 criteria, which focus on organ dysfunction as a key diagnostic feature. Scoring systems, such as the Sequential Organ Failure Assessment (SOFA) score and the Quick SOFA (qSOFA) score, are discussed in terms of their components, calculation, and interpretation. The diagnostic markers section details the clinical, laboratory, and microbiological parameters used in sepsis diagnosis, highlighting traditional markers and emerging technologies. The conclusion summarizes the key points and emphasizes the importance of early recognition and adherence to evidence-based guidelines for improving sepsis outcomes.

Point-of-care ultrasonography in nephrology: Growing applications, misconceptions and future outlook

Ultrasound has long been an essential tool in nephrology, traditionally used for procedures like vascular access and kidney biopsies. Point-of-care ultrasonography (POCUS), a rapidly evolving bedside technology, is now gaining momentum in nephrology by providing real-time imaging to enhance physical examination findings. Unlike comprehensive radiology-performed ultrasound, POCUS focuses on specific clinical questions, providing immediate and actionable insights. This narrative review examines the philosophy behind POCUS, its expanding applications in nephrology, and its impact on patient care, including its role in diagnosing obstructive uropathy, guiding fluid management, and evaluating hemodynamics in cardiorenal syndrome. Additionally, the review addresses barriers to widespread adoption, such as the need for structured training, competency validation, and interdisciplinary cooperation. By integrating POCUS into routine practice, nephrologists can refine diagnostic accuracy, improve patient outcomes, and strengthen the role of bedside medicine.

Therapeutic effects of Saussurea graminea Dunn and its active compounds in sepsis-associated liver injury: Transcriptomics, metabolomics and experimental validation

ETHNOPHARMACOLOGICAL RELEVANCE

Saussurea graminea Dunn (SG), a traditional Chinese medicinal herb known as "Za Chi" in Tibet of China, is frequently utilized in the treatment of inflammatory diseases such as hepatitis. However, the active ingredients and mechanism of its therapeutic effect on Sepsis - associated liver injury (SALI) remain unclear.

AIM OF THE STUDY

To elucidate the effect of SG in combating SALI, uncover its mechanism of action, and explore possible active compounds.

MATERIALS AND METHODS

We established a SALI model by intraperitoneal injection of lipopolysaccharide to assess the efficacy of SG. Transcriptomics and metabolomics were employed to reveal its possible mechanism of action. Subsequently, Western blot, flow cytometry, confocal microscopy, quantitative PCR, HPLC-MS, and molecular docking were utilized to verify its mechanism and active ingredients.

RESULTS

SG effectively counteracts SALI by inhibiting the cytokine storm. Transcriptomics indicates that SG regulates SALI through mitochondrial/TNF and metabolic pathways. Metabolomics demonstrates that arachidonic acid metabolism is involved in the process of SG treating SALI. HPLC-MS identified the main components of SG as chlorogenic acid, syringin, scopoletin, rutin, isochlorogenic acid, and narcissin, and these six compounds were confirmed as potential active components in the RAW264.7 inflammation model.

CONCLUSION

SG and its active ingredients play a role in alleviating SALI by reducing the cytokine storm through mtDNA/TNF/arachidonic acid metabolism.

Source control in intra-abdominal infections: What you need to know

ABSTRACT

Providing optimal source control (SC) for intra-abdominal sepsis (IAS) is a critically important surgical principle, yet one that remains nebulous in terms of strict definitions and required conduct. The entire concept of SC has evolved in the last decades. Contemporary SC is not only surgical but also embraces minimally invasive percutaneous and medical therapies. We propose that adequate SC has evolved from the mere anatomical control of enteric leakage, cleansing of obvious contaminants and necrosis, to a more comprehensive anatomo-phyiological-biochemical model. While any breaches in the integrity of the gastrointestinal tract should be addressed urgently, SC should ultimately aim to control the generation and propagation of systemic biomediators, bacterial toxins, and toxic catabolites that perpetuate multisystem organ failure and death. Much urgently needs to be learned to understand and hopefully mitigate the dysbiotic influences of IAS on the human microbiome. Finally, the therapy offered should always be individualized, recognizing patient's unique pathophysiology, clinical condition, comorbidities, and predeclared preferences regarding invasive therapies and life-support.

Why should lymphocytes immune profile matter in sepsis?

The global incidence of critical illness has been steadily increasing, resulting in higher mortality rates thereby presenting substantial challenges for clinical management. Among these conditions, sepsis stands out as the leading cause of critical illness, underscoring the urgent need for continued research to enhance patient care and deepen our understanding of its complex pathophysiology. Lymphocytes play a pivotal role in both innate and adaptive immune responses, acting as key regulators of the balance between pro-inflammatory and anti-inflammatory processes to preserve immune homeostasis. In the context of sepsis, an impaired immunity has been associated with disrupted lymphocytic metabolic activity, persistent pro-inflammatory state, and subsequent immunosuppression. These disruptions not only impair pathogen clearance but also predispose patients to secondary infections and hinder recovery, highlighting the importance of targeting lymphocyte dysfunction in sepsis management. Moreover, studies have identified absolute lymphocyte counts and derived parameters as promising clinical biomarkers for prognostic assessment and therapeutic decision-making. In particular, neutrophil-to-lymphocyte ratio, and lymphopenia have gained recognition in the literature as a critical prognostic markers and therapeutic target in the management of sepsis. This review aims to elucidate the multifaceted role of lymphocytes in pathophysiology, with a focus on recent advancements in their use as biomarkers and key findings in this evolving field.

Cannabis use disorder and severe sepsis outcomes in cancer patients: Insights from a national inpatient sample

BACKGROUND

The burden of cannabis use disorder (CUD) in the context of its prevalence and subsequent cardiopulmonary outcomes among cancer patients with severe sepsis is unclear.

AIM

To address this knowledge gap, especially due to rising patterns of cannabis use and its emerging pharmacological role in cancer.

METHODS

By applying relevant International Classification of Diseases, Ninth and Tenth Revision, Clinical Modification codes to the National Inpatient Sample database between 2016-2020, we identified CUD(+) and CUD(-) arms among adult cancer admissions with severe sepsis. Comparing the two cohorts, we examined baseline demographic characteristics, epidemiological trends, major adverse cardiac and cerebrovascular events, respiratory failure, hospital cost, and length of stay. We used the Pearson χ 2 d test for categorical variables and the Mann-Whitney U test for continuous, non-normally distributed variables. Multivariable regression analysis was used to control for potential confounders. A P value ≤ 0.05 was considered for statistical significance.

RESULTS

We identified a total of 743520 cancer patients admitted with severe sepsis, of which 4945 had CUD. Demographically, the CUD(+) cohort was more likely to be younger (median age = 58 vs 69, P < 0.001), male (67.9% vs 57.2%, P < 0.001), black (23.7% vs 14.4%, P < 0.001), Medicaid enrollees (35.2% vs 10.7%, P < 0.001), in whom higher rates of substance use and depression were observed. CUD(+) patients also exhibited a higher prevalence of chronic pulmonary disease but lower rates of cardiovascular comorbidities. There was no significant difference in major adverse cardiac and cerebrovascular events between CUD(+) and CUD(-) cohorts on multivariable regression analysis. However, the CUD(+) cohort had lower all-cause mortality (adjusted odds ratio = 0.83, 95% confidence interval: 0.7-0.97, P < 0.001) and respiratory failure (adjusted odds ratio = 0.8, 95% confidence interval: 0.69-0.92, P = 0.002). Both groups had similar median length of stay, though CUD(+) patients were more likely to have higher hospital cost compared to CUD(-) patients (median = 94574 dollars vs 86615 dollars, P < 0.001).

CONCLUSION

CUD(+) cancer patients with severe sepsis, who tended to be younger, black, males with higher rates of substance use and depression had paradoxically significantly lower odds of all-cause in-hospital mortality and respiratory failure. Future research should aim to better elucidate the underlying mechanisms for these observations.

Causality of genetically predicted solid cancers on risk of sepsis: insights from Mendelian randomization

OBJECTIVE

Some studies have found that solid cancer and sepsis are linked. The primary objective of this study is to explore this connection further, investigating the causal effect of solid cancer on sepsis by applying Mendelian randomization (MR).

METHODS

Using genome-wide association study (GWAS) data from the Medical Research Council-Integrative Epidemiology Unit database, we conducted a bidirectional two-sample Mendelian randomization (MR) analysis to test the causal association between solid cancers (10 GWAS, 1,345,730 samples) and sepsis (2 GWAS, 1,288,566 samples) in European ancestry. In the context of multivariable MR analysis, lifestyle risk factors such as body mass index (BMI) were incorporated, with relevant clinical interventions taken into account.

RESULTS

The two-sample MR analysis suggested a causal relationship between renal cancer and sepsis (OR = 1.051, 95% CI = 1.019-1.085, PIVW = 1.800E-03). Renal cancer (OR = 1.064, 95% CI = 1.011-1.120, PIVW = 1.60E-02), BMI (OR = 1.315, 95% CI = 1.176-1.471, PIVW = 1.25E-06), and smoking (OR = 1.139, 95% CI = 1.009-1.286, PIVW = 3.65E-02) showed a significant association with sepsis in our lifestyle multivariable MR analysis. Reverse MR analysis indicates that sepsis may prevent renal cancer. (OR = 0.924, 95% CI = 0.865 -0.988, PIVW = 2.060E-02).

CONCLUSIONS

Our findings suggest renal cancer is correlated with the occurrence of sepsis. This association is partially influenced by BMI and smoking. Unexpectedly, sepsis may act as a protective effect against renal cancer.

Impact of differences between interim and post-interim analysis populations on outcomes of a group sequential trial: Example of the MOVe-OUT study

BackgroundPre-specified interim analyses allow for more timely evaluation of efficacy or futility, potentially accelerating decision-making on an investigational intervention. In such an analysis, the randomized, double-blind MOVe-OUT trial demonstrated superiority of molnupiravir over placebo for outpatient treatment of COVID-19 in high-risk patients. In the full analysis population, the point estimate of the treatment difference in the primary endpoint was notably lower than at the interim analysis. We conducted a comprehensive assessment to investigate this unexpected difference in treatment effect size, with the goal of informing future clinical research evaluating treatments for rapidly evolving infectious diseases.MethodsThe modified intention-to-treat population of the MOVe-OUT trial was divided into an interim analysis cohort (i.e. all participants included in the interim analysis; prospectively defined) and a post-interim analysis cohort (i.e. all remaining participants; retrospectively defined). Baseline characteristics (including many well-established prognostic factors for disease progression), clinical outcomes, and virologic outcomes were retrospectively evaluated. The impact of changes in baseline characteristics over time was explored using logistic regression modeling and simulations.ResultsBaseline characteristics were well-balanced between arms overall. However, between- and within-arm differences in known prognostic baseline factors (e.g. comorbidities, SARS-CoV-2 viral load, and anti-SARS-CoV-2 antibody status) were observed for the interim and post-interim analysis cohorts. For the individual factors, these differences were generally minor and otherwise not notable; as the trial progressed, however, these shifts in combination increasingly favored the placebo arm across most of the evaluated factors in the post-interim cohort. Model-based simulations confirmed that the reduction in effect size could be accounted for by these longitudinal trends toward a lower-risk study population among placebo participants. Infectivity and viral load data confirmed that molnupiravir's antiviral activity was consistent across both cohorts, which were heavily dominated by different viral clades (reflecting the rapid SARS-CoV-2 evolution).DiscussionThe cumulative effect of randomly occurring minor differences in prognostic baseline characteristics within and between arms over time, rather than virologic factors such as reduced activity of molnupiravir against evolving variants, likely impacted the observed outcomes. Our results have broader implications for group sequential trials seeking to evaluate treatments for rapidly emerging pathogens. During dynamic epidemic or pandemic conditions, adaptive trials should be designed and interpreted especially carefully, considering that they will likely rapidly enroll a large post-interim overrun population and that even small longitudinal shifts across multiple baseline variables can disproportionately impact prespecified efficacy outcomes at different timepoints. Shifts in prognostic factors may introduce additional variability that can be difficult to disentangle from temporal trends in epidemiology (e.g. evolutionary changes in the causative pathogen) or disease management.(ClinicalTrials.gov: NCT04575597.).

Diuretics in critically ill patients: a narrative review of their mechanisms and applications

Diuretics remain the cornerstone therapy of critically ill patients with volume overload as a result of cardiac failure, acute kidney injury or aggressive fluid resuscitation. This review summarises the principles of applied renal physiology, describing the mechanisms of action, the clinical applications, and the adverse effects of commonly used diuretics during critical illness. Loop diuretics, and in particular furosemide, remain the most popular, despite evidence of any effect on mortality or, indeed, on the need for renal replacement therapy. The efficacy of loop diuretics after administration depends on three factors. Firstly, the tubular concentration of the diuretic: continuous infusion of furosemide seems to provide a higher and more stable tubular concentration of furosemide with respect to bolus injection. Secondly, the interaction with albumin both in the plasma and in the renal tubule: despite a strong physiological rationale supporting this approach, albumin supplementation in hypoalbuminaemic patients does not seem to result in a higher diuretic efficacy. Thirdly, diuretic resistance, which can be addressed by optimising loop diuretic dose and by using combination therapy with other agents, including thiazides or thiazide-like diuretics or carbonic anhydrase inhibitors. These drugs constitute a useful adjunct to overcome loop diuretic resistance. Other agents such as distal potassium-sparing diuretics and osmotic diuretics can also be considered. The latter have been used successfully in hypokalaemia, rhabdomyolysis-associated acute kidney injury or to prevent ischaemia-reperfusion injury in kidney transplantation. Finally, this review provides the basic concepts of the interplay between acid-base equilibrium and diuretic therapy.

Penetrating trauma in Spain: analysis of the Spanish trauma registry (RETRAUCI)

OBJECTIVE

To describe the epidemiology of penetrating trauma, mortality associated factors and its management in Spanish intensive care units.

DESIGN

Multicenter, prospective registry. A comparison is established between two cohorts defined by the type of trauma (blunt and penetrating).

PATIENTS

Patients with traumatic injury admitted to the participating ICUs from June 2015 to June 2022.

INTERVENTIONS

None.

MAIN VARIABLE OF INTEREST

Epidemiology, injury pattern, prehospital and hospital care, resource utilization, and clinical outcomes.

RESULTS

12,806 patients were eligible, of whom 821 (6.4%) suffered penetrating trauma; 418 patients (50.9%) from stab wounds, 93 (11.3%) from gunshot wounds, and 310 (37.8%) from other objects. The most common intent was assault (47.7%). The mean ISS was 15.2 ± 10.6 in penetrating trauma and 19.8 ± 11.9 in blunt trauma (p < 0.001). ICU mortality was 7.8% compared to 11.7% in blunt trauma, with deaths more frequently occurring within the first 24 hours (64% vs. 39%). Factors associated with mortality included female sex, prior use of antithrombotic agents, older age, higher NISS score, and the presence of cranial trauma or shock.

CONCLUSIONS

Penetrating trauma is an emergent pathology in our context with high complexity, highlighting the need for focused study and documentation, protocol development, and resource optimization to provide quality care.

Delta shock index in the emergency department as a predictor of clinical outcomes in traumatic injury

OBJECTIVES

The shock index (SI) is widely used to screen for patients in shock, and the dSI is created by utilizing prehospital SI and emergency department SI to enhance predictive accuracy. However, few have compared dSI with prehospital SI and SI at ED, and even fewer have explored the directional changes in dSI. This study aims to evaluate the prediction accuracy of prehospital SI, SI at ED, and delta SI in trauma patients, proposing that the delta scoring systems provide a more precise tool for field triage.

PATIENTS AND METHODS

This study conducted a cohort analysis involving 48,524 patients from the trauma registry data at Tzu Chi Hospital. The three primary outcomes assessed were in-hospital mortality, intensive care unit (ICU) admission, and prolonged total length of hospital stay (≥ 30 days). The area under the receiver operating characteristic curve (AUROC) for these scores was calculated and compared using the DeLong test. The delta SI was calculated as the difference between prehospital SI and SI at the emergency department (ED). The dSI was categorized into five groups: dSI < -0.5, -0.5 ≤ dSI < -0.1, -0.1 ≤ dSI < 0.1, 0.1 ≤ dSI < 0.5, and 0.5 ≤ dSI.

RESULTS

Prehospital SI, SI at ED, and dSI were significant predictors of in-hospital mortality, ICU admission, and prolonged length of stay (LOS) of ≥30 days. Compared to prehospital SI and SI at ED, dSI demonstrated significantly higher AUROC values in discriminating major injury, prolonged ICU stay, and in-hospital mortality. The groups with dSI < -0.5 and dSI ≥ 0.5 exhibited a significantly higher risk of in-hospital mortality compared to other dSI group with adjusted odds ratio (aOR) of 2.170 and 2.976. A J-shaped relationship in aOR values was observed across different dSI ranges for in-hospital mortality. The dSI ≥ 0.5 group had an increased risk of in-hospital mortality among elderly patients, those with major or minor injuries, and both TBI and non-TBI groups. The dSI ≥ 0.1 demonstrated accuracies of 80.94 % for predicting ISS ≥ 16, 72.91 % for ICU admission, 87.14 % for prolonged LOS ≥ 30 days, and 89.33 % for predicting mortality.

CONCLUSIONS

The dSI demonstrated significantly better discriminative ability for major injury, prolonged ICU stay, and in-hospital mortality. A potential J-shaped relationship has been identified between dSI and mortality, indicating that both the dSI < -0.5 and dSI ≥ 0.5 groups have a significantly higher risk of in-hospital mortality. It is anticipated that dSI will be integrated into clinical practice for the field triage of trauma patients in the future.

Size Matters: Endotracheal Tube Sizes and Glottic Stenosis Familiarity Among Intubating Physicians

Objective

Given the prevalence of post-intubation acute laryngeal injury (ALgI) and its association with glottic stenosis, greater attention has been placed on the mitigation of modifiable risk factors in patients requiring intubation, notably endotracheal tube (ETT) size. No widely accepted guidelines for adult ETT sizing exist. To better understand how factors driving ETT sizing may differ across specialties, we conducted a survey of faculty Anesthesiologists, Intensivists, and Emergency Medicine (EM) physicians.

Methods

An anonymous 14-question Qualtrics survey was distributed to relevant faculty employed at a single tertiary care institution. Participants completed questions pertaining to their training, ETT sizing preferences, factors considered in decision-making, and perceived knowledge regarding risk factors of glottic stenosis.

Results

A total of 103 complete responses were included, with a response rate of 55.1%. Standard ETT size was reported by 94 (91.3%) respondents to be 7.5 mm or larger in adult males and by 92 (89.3%) respondents to be 7.0 mm or larger in adult females. All respondents preferred a significantly larger ETT size for males compared to females (all p < 0.001). "Need for bronchoscopy" was the most cited factor precluding both males and females from being intubated with a smaller ETT across all specialties. When queried on posterior glottic stenosis, 64 (62.1%) respondents erroneously identified cuff pressure as a risk factor.

Conclusions

Understanding ETT sizing among intubating physicians is critical to reducing intubation-related ALgI. Future laryngologist-led interventions may be directed toward the adoption of a predominately height-based model for ETT sizing and education on glottic stenosis.

Level of Evidence

5.

A scoping review on the integration of artificial intelligence in point-of-care ultrasound: Current clinical applications

BACKGROUND

Artificial intelligence (AI) is used increasingly in point-of-care ultrasound (POCUS). However, the true role, utility, advantages, and limitations of AI tools in POCUS have been poorly understood.

AIM

to conduct a scoping review on the current literature of AI in POCUS to identify (1) how AI is being applied in POCUS, and (2) how AI in POCUS could be utilized in clinical settings.

METHODS

The review followed the JBI scoping review methodology. A search strategy was conducted in Medline, Embase, Emcare, Scopus, Web of Science, Google Scholar, and AI POCUS manufacturer websites. Selection criteria, evidence screening, and selection were performed in Covidence. Data extraction and analysis were performed on Microsoft Excel by the primary investigator and confirmed by the secondary investigators.

RESULTS

Thirty-three papers were included. AI POCUS on the cardiopulmonary region was the most prominent in the literature. AI was most frequently used to automatically measure biometry using POCUS images. AI POCUS was most used in acute settings. However, novel applications in non-acute and low-resource settings were also explored. AI had the potential to increase POCUS accessibility and usability, expedited care and management, and had a reasonably high diagnostic accuracy in limited applications such as measurement of Left Ventricular Ejection Fraction, Inferior Vena Cava Collapsibility Index, Left-Ventricular Outflow Tract Velocity Time Integral and identifying B-lines of the lung. However, AI could not interpret poor images, underperformed compared to standard-of-care diagnostic methods, and was less effective in patients with specific disease states, such as severe illnesses that limit POCUS image acquisition.

CONCLUSION

This review uncovered the applications of AI in POCUS and the advantages and limitations of AI POCUS in different clinical settings. Future research in the field must first establish the diagnostic accuracy of AI POCUS tools and explore their clinical utility through clinical trials.

Effect of early administration of inhaled heparin on outcomes of smoke inhalation injury: A randomized controlled trial

BACKGROUND

The present study aimed to examine the effects of early administration of inhaled heparin on the outcome of smoke inhalation injury.

METHODS

Eighty-eight adults suffering smoke inhalation injury within 24 h were randomized to receive 5000 IU of heparin (n = 44) or normal saline (n = 44) by nebulization every 4 h until successful extubation or death, up to a maximum of 14 days. The primary outcome was ventilator-free days (VFDs) and alive at 28 days. The secondary outcomes included the intensive care unit (ICU)-free days and alive at 28 days, change in the PaO2/FiO2 ratio, 28-day all-cause mortality rate, and mechanical ventilation days in survivors.

RESULTS

When adjusted to the burn area and burn-to-randomization time, inhaled heparin was associated with more VFDs (P =.046) and a higher cumulative incidence of weaning from mechanical ventilation over time (P =.007). Patients receiving inhaled heparin had more ICU-free days (P =.015), higher PaO2/FiO2 ratio (P =.001), and fewer mechanical ventilation days in survivors (P <.001), but the mortality rate was comparable to the control group (P =.596).

CONCLUSIONS

The early administration of inhaled heparin to patients suffering smoke inhalation injury was associated with more VFDs and enhanced weaning from mechanical ventilation. Inhaled heparin was also associated with more ICU-free days, higher PaO2/FiO2 ratios, and fewer mechanical ventilation days in survivors. Larger randomized controlled trials are required to establish the role of inhaled heparin as a standard of care in this clinical setting.

Extra-abdominal CT imaging indicates increased severity of illness in advanced age patients requiring emergency abdominal surgery

BACKGROUND

Abdominal sepsis frequently causes neurologic and pulmonary dysfunction among geriatric patients, We hypothesize that patients with abdominal sepsis who undergo extra-abdominal imaging have a greater burden of illness.

METHODS

Patients 65 years and older that underwent emergency abdominal surgery for sepsis were divided into those with abdominal only(AbdCT) versus abdominal and extra-abdominal(ExtraCT) imaging.

RESULTS

ExtraCT patients(N ​= ​30) compared to AbdCT(N ​= ​97) had higher rates of dementia(13.3 ​% versus 3.3 ​%; p ​= ​0.03), diabetes(93.3 ​% versus 60.1 ​%; p ​< ​0.01 and COPD(70 ​% versus 29.9 ​%; p ​< ​0.01) but lower rates of abdominal pain as chief complaint (23.3 ​% versus 81.4 ​%; p ​< ​0.01) and higher rates of being qSOFA positive (33.3 ​% vs 7.2 ​%; p ​< ​0.05). Importantly, time to OR was not different between groups. ExtraCT patients had higher rates of 30-day mortality (33.3 ​% vs 5.2 ​%; p ​< ​0.01). Extra-abdominal CT imaging was associated with increased risk of mortality (OR ​= ​5.4; 95 %CI ​= ​1.4-20.1).

CONCLUSIONS

ExtraCT among geriatric patients with abdominal emergencies is a marker of severity of illness and should guide end-of-life decision making.

How does drug abuse affect outcomes after trauma? A trauma quality improvement program study

BACKGROUND

The protective effects of drug abuse on ICU admissions and ventilator weaning after trauma are debated. This study examines the impact of drug abuse on mortality, ICU admissions, and complications.

METHODS

Trauma patients ≥16 years from the TQIP database (2020-2022) with admission toxicology testing (TOX) were analyzed. The primary outcome was mortality; secondary outcomes included in-hospital complications.

RESULTS

Among 861,450 patients, decreased mortality odds were noted with cannabinoid (OR ​= ​0.842), amphetamine (OR ​= ​0.800), cocaine (OR ​= ​0.851), opioid (OR ​= ​0.625), and benzodiazepine (OR ​= ​0.843) (P ​< ​0.001). Reduced ICU admission odds were linked to opioid (OR ​= ​0.882), barbiturate (OR ​= ​0.824), oxycodone (OR ​= ​0.829), ecstasy (OR ​= ​0.811), and methadone (OR ​= ​0.809). Lower intubation odds were seen with opioid (OR ​= ​0.663), barbiturate (OR ​= ​0.733), oxycodone (OR ​= ​0.754), and ecstasy (OR ​= ​0.627). Methamphetamine (OR ​= ​0.682) was associated with reduced ARDS odds.

CONCLUSIONS

Recreational drugs may independently reduce ICU admissions, intubation, and mortality, warranting further investigation.

LEVEL OF EVIDENCE

Level III retrospective study.

[Vasoactive agents in septic shock-individualized strategies]

Hemodynamic stabilization and preservation of organ perfusion are central elements in the management of septic shock. This is achieved by fluid resuscitation and by administration of vasoactive agents. Current guidelines recommend norepinephrine as the first-line vasoactive substance. In cases of high norepinephrine requirements the addition of nonadrenergic vasopressors is recommended. Furthermore, evidence suggests that early use of complementary vasoactive substances may provide additional benefits. Such a regimen, in terms of a broad-spectrum vasopressor approach, appears physiologically plausible. Post hoc analyses of studies investigating vasopressin or angiotensin II also suggest that specific subphenotypes may particularly benefit from individual vasoactive agents. Adjunctive therapy with hydrocortisone and fludrocortisone can improve vasopressor responsiveness and reduce mortality. In cases of cardiac dysfunction, a trial with dobutamine or a switch from norepinephrine to epinephrine is recommended. To enhance inodilator effects, milrinone or levosimendan may represent additional therapeutic options for certain patients. Although short-acting beta-blockers are not part of the standard treatment for septic shock, they may, in selected cases, contribute to hemodynamic improvement in patients with inadequately high sinus tachycardia or atrial tachyarrhythmias. Based on pathophysiological considerations and the currently available evidence, targeted use of specific vasoactive substances in defined subphenotypes may be justified. An initial broad-spectrum vasopressor strategy incorporating biomarkers such as renin and patient-specific characteristics followed by a focused de-escalation approach could represent a promising concept. However, the effectiveness of these strategies requires further investigation in randomized controlled trials.

Can Opportunistic Use of Computed Tomography Help Reveal the Association Between Hepatic Steatosis and Disease Severity in Hospitalized COVID-19 Patients?

To measure hepatic steatosis (HS) in hospitalized COVID-19 patients using unenhanced chest computed tomography (CT) imaging and to evaluate the relationship between disease severity and prognosis in adult patients.This retrospective study included 152 consecutive hospitalized COVID-19 patients with a positive reverse transcriptase polymerase chain reaction (RT-PCR) test. The COVID-19 Reporting and Data System (CO-RADS) and the chest CT score were evaluated. HS measurements were performed based on CT images using a single region of interest placed on the right liver lobe (segments V-VII). HS was defined as a liver attenuation value <40 Hounsfield units. Data were collected and compared with the patients' prognostic parameters.Of the 152 inpatients, 137 patients (90.1%) had a CT score ≥3 and 109 patients (71.7%) had a CO-RADS score ≥4, 43 (28.2%) had HS. All patients with HS (100%) and 94/109 (86.2%) patients without HS had a CT score ≥3. There was a statistically significant difference between the two groups in terms of chest CT score (p=0.006). There was no statistically significant difference between the two groups in terms of CO-RADS score (p=0.291). The median CRP levels were significantly increased in patients with HS compared to patients without HS (p=0.023). There was no significant difference in ICU hospitalization and mortality due to the presence of HS (p>0.05).The current study revealed significantly higher chest CT scores in COVID-19 patients with HS measured on CT compared to those without HS. Opportunistic use of CT images for the detection of HS can be considered as an adjunctive tool in the risk analysis of COVID-19 patients hospitalized due to COVID-19 pneumonia.The severity of COVID-19 disease is increased in hospitalized patients with hepatosteatosis compared to patients with a normal liver. Density measurements for the evaluation of HS using opportunistic CT applications can be considered as an adjunctive tool in the prognostic evaluation of hospitalized patients with COVID-19 pneumonia. · Parlak AE, Erdem Toslak İ, Turkoglu Selcuk N. Can Opportunistic Use of Computed Tomography Help Reveal the Association Between Hepatic Steatosis and Disease Severity in Hospitalized COVID-19 Patients?. Rofo 2025; 197: 648-656.

Trauma disparities occur upstream from hospitals: Neighborhood social vulnerability predicts incidence of various traumatic injuries but not case fatality

BACKGROUND

Trauma is a complex disease process often affecting the most vulnerable members of society. This cross-sectional study aims to identify the relationship between incidence and case fatality rate of injury with the Social Vulnerability Index (SVI), a composite score of community disparity.

METHODS

A convenience sample of six State Inpatient Databases from 2016, provided by the Healthcare Cost Utilization Project, was generated for patients older than 18 years with specific International Classification of Diseases, Tenth Revision, codes for external cause of injury. Individual ZIP codes were converted to census tracts, and SVI scores were assigned to each census tract divided each admission into an SVI quintile. Multivariable Poisson regression was used to assess association between incidence of traumatic events, case fatality, and SVI quintiles, adjusted for age, sex, state, and new Injury Severity Score.

RESULTS

A total of 396,209 unique hospital admissions were included in the cohort. Injury from fall was the most common trauma, occurring in 308,280 admissions (77.8%). Proportionally, the highest SVI quintile (most vulnerable) experienced the most traumatic events across all injury categories. In those who experienced assault, the highest SVI quintile had over eight times greater incidence of injury compared with the lowest quintile (incidence rate ratio, 8.92; p < 0.001). The association of higher SVI and incidence of injuries persisted across all categories after adjusting for age, sex, and state. There was no meaningful association between case-fatality rate and SVI quintile in any traumatic injury category, before or after adjustment for Injury Severity Score, except for when age adjustment was removed from the model.

CONCLUSION

Populations from more socially vulnerable neighborhoods experience traumatic events at higher rates than those living in low SVI neighborhoods. However, community social vulnerability was not associated with a clinically significant difference in in-hospital case-fatality rate, except when age adjustment was removed from the model. Understanding how the most vulnerable populations experience traumatic events differently can inform policy and guide targeted upstream preventative measures within vulnerable communities.

LEVEL OF EVIDENCE

Observational/Cross-sectional (STROBE checklist attached); Level III.

Sedation practices in patients intubated in the emergency department compared with those in patients in the intensive care unit

OBJECTIVE

This study aimed to compare sedation management during and after intubation in the emergency department with that in the intensive care unit.

METHODS

This was a single-center retrospective cohort study of adults who were intubated in the emergency department or intensive care unit and who received mechanical ventilation between January 2018 and February 2022. We collected data from electronic medical records. The primary outcome was the duration from intubation to the first documentation of light sedation, which was defined as a Sedation Agitation Scale score of 3 - 4.

RESULTS

This study included 264 patients, 95 (36%) of whom were intubated in the emergency department and 169 (64%) in the intensive care unit. With respect to the anesthetic agents used for intubation, ketamine was the most frequently used drug in the emergency department and was used more frequently than in the intensive care unit (61% versus 40%; p = 0.001). Propofol was the predominant sedative used in the intensive care unit, with a higher prevalence than in the emergency department (50% versus 33%; p = 0.01). Additionally, benzodiazepines and fentanyl were more frequently used in the intensive care unit (39% versus 6%; p < 0.001 and 68% versus 9.5%; p < 0.001, respectively). Within 24 hours after intubation, 68% (65/95) of the emergency department patients and 82% (138/169) of the patients intubated in the intensive care unit achieved light sedation, with median durations of 13.5 hours and 10.5 hours, respectively. Patients who were intubated in the emergency department were less likely to achieve light sedation at 24 hours (adjusted hazard ratio 0.64; p = 0.04; 95%CI, 0.42 - 0.97).

CONCLUSION

Compared with intensive care unit patients, critically ill patients who were intubated in the emergency department are at risk of deeper sedation and a longer time to achieve light sedation.

Low-pressure tamponade due to hemothorax after transcatheter edge-to-edge repair of the mitral valve

BACKGROUND

The use of percutaneous transcatheter edge-to-edge repair (TEER) for mitral regurgitation (MR) has increased, including an increased application to older, frailer, and higher risk patients.

CASE SUMMARY

A 74 year-old woman with severe MR, a left ventricular ejection fraction of 45%, and a small circumferential pericardial effusion underwent TEER of the mitral valve. After the placement of two MitraClips, the MR was assessed as mild to moderate. Within 10-20 minutes after the completion of the case, the patient was dyspneic and hypotensive despite volume resuscitation. Point-of-care ultrasound (POCUS) showed no changes in cardiac contractility, valve function, or the pericardial space. The right heart chambers appeared small with right atrial (RA) diastolic collapse. There was no evidence of venous congestion. Further exam showed a large right pleural fluid collection. Given the clinical scenario of dyspnea, hypotension, and diastolic RA collapse, low-pressure tamponade was suspected. A thoracentesis expelled 1200 mL of blood with immediate hemodynamic improvement. The patient made an uneventful recovery.

CONCLUSION

The application of POCUS is crucial for detecting, diagnosing, and properly managing cardiac dysfunction and procedural complications associated with TEER. While tamponade is classically associated with a pericardial effusion and vena caval plethora, their absence does not dismiss the suspicion or diagnosis of tamponade. This case highlights the value of POCUS in assessing low-pressure tamponade caused by a large, pressurized pleural effusion. Clinical suspicion, supported by POCUS findings, was confirmed by a thoracentesis that resulted in immediate hemodynamic improvement.

Major Traumatic Injury and Exposure to Mitochondrial-Derived Damage-Associated Molecular Patterns Promotes Neutrophil Survival Accompanied by Stabilisation of the Anti-Apoptotic Protein Mcl-1

Traumatic injury leads to an extension of the half-life of circulating neutrophils. However, how quickly neutrophil apoptosis is delayed post-injury is currently unknown, as are the underlying mechanisms and factors that promote this extension of lifespan. During the ultra-early (≤1 h) and acute (4-12 and 48-72 h) post-injury phases, we collected blood samples from 73 adult trauma patients. Following ex vivo culture, neutrophil apoptosis was measured, alongside caspase-3 activation and expression of the anti-apoptotic protein Mcl-1. To identify factors that may promote neutrophil survival post-trauma, neutrophils from healthy controls (HCs) were cultured with mitochondrial-derived damage-associated molecular patterns (mtDAMPs) or mitochondrial DNA (mtDNA). Accompanied by reduced mitochondrial membrane depolarisation, delayed Mcl-1 turnover, and reduced caspase-3 activation, the ex vivo lifespan of neutrophils from trauma patients was significantly enhanced in a protein synthesis-independent manner within minutes to hours after injury. Neutrophils from HCs exhibited delayed apoptosis when cultured in media supplemented with trauma patient serum, which occurred alongside stabilisation of Mcl-1. Culturing HCs neutrophils with mtDAMPs or mtDNA significantly delayed apoptosis rates, promoted stabilisation of Mcl-1, and reduced caspase-3 activation. The release of mtDAMPs from damaged tissue may drive post-trauma immune dysregulation by promoting the survival of dysfunctional neutrophils.

Cardiovascular comorbidities predict mortality in acute pancreatitis

BACKGROUND

The in-hospital mortality of acute pancreatitis (AP) is determined by severity of AP, but also significantly impacted by patients' comorbidities. Therefore, we aimed to examine the association between comorbid risk-profiles and survival in hospitalized patients admitted with AP.

METHODS

We utilized the German nationwide inpatient statistics to identify all AP patient-cases (ICD code K85) admitted to hospitals in Germany between 2005 and 2019. Hospitalization cases for AP were stratified by survival, and risk factors for in-hospital mortality were examined.

RESULTS

In total, 797,364 hospitalization-cases of patients admitted due to AP (median age 56.0 [IQR 44.0-71.0] years, 39.2 % females) were treated in Germany 2005-2019. Of these, 22,022 (2.8 %) patients died during hospitalization. AP survivors were younger (56.0 [44.0-71.0] vs. 76.0 [64.0-84.0], P < 0.001), more often males (61.0 % vs. 54.1 %, P < 0.001), and were less often afflicted by cardiovascular risk factors and diseases than non-survivors. Cardiovascular diseases (OR 2.08 (95 %CI 2.02-2.15), P < 0.001) and raising number of cardiovascular diseases (OR 1.48 (95 %CI 1.45-1.50), P < 0.001) were independently associated with increasing mortality. In particular, heart failure (OR 2.16 [95 %CI 2.09-2.24], P < 0.001), peripheral artery disease (OR 1.25 [1.15-1.35], P < 0.001), atrial fibrillation/flutter (OR 1.61 [95 %CI 1.55-1.66], P < 0.001), myocardial infarction (OR 4.71 [95 %CI 4.28-5.18], P < 0.001), pulmonary embolism (OR 12.19 [95 %CI 10.91-13.62], P < 0.001), and stroke (OR 7.21 [95 %CI 6.42-8.11], P < 0.001) were independently associated with in-hospital mortality.

CONCLUSIONS

Between 2005 and 2019, the in-hospital mortality among hospitalized AP patients was 2.8 % in Germany. Presence of cardiovascular diseases was associated with significantly reduced survival in AP patients.

Endotoxin hemoadsorption in refractory septic shock with multiorgan dysfunction and extreme endotoxin activity

Endotoxin septic shock is marked by severe organ failure and mortality rate that exceeds fifty percent, underscoring the critical need to tailor management strategies. Monitoring -endotoxin activity can guide the initiation and direction of adjunctive treatment for refractory septic shock through hemoadsorption. Thus, intervening based on the pathophysiological foundation may potentially improve outcomes. This represents a step towards precision medicine in the management of septic shock adjunctive therapies, addressing a knowledge gap in this pathology that remains insufficiently defined. Despite its potential, in the setting of refractory septic shock and multiorgan dysfunction with extreme endotoxin activity (EAA ≥ 0.9), the data about efficacy of endotoxin hemoadsorption is scarce.

In Vitro Immune Response of Mononuclear Cells to Multidrug-Resistant Escherichia coli

Infections caused by multidrug-resistant organisms (MDRO) are linked to poor outcomes, particularly in patients with cirrhosis. The underlying mechanisms are not fully understood and may involve a different immune response against MDRO. This study aimed to compare the in vitro immune response between multidrug-resistant (MDR) Escherichia coli and antibiotic-susceptible E. coli strains. Surface protein extract and DNA extract were obtained from MDR E. coli (n = 6) and antibiotic-susceptible E. coli (n = 6) strains isolated from infected patients with cirrhosis. The extracts were used to stimulate in vitro peripheral blood mononuclear cells from healthy donors. After 48 h, cytokine levels (IFN-γ, IL-1β, IL-10, IL-12p70, MCP-1, IL-8, IL-6, MIP-1α, and MIP-1β) were measured. We observed no significant differences in cytokine production between MDR and susceptible strains. However, we identified notable interindividual variability in cytokine production for most of the cytokines studied. Only IFN-γ and IL-6 in surface extract and MCP-1 in DNA extract showed similar levels across all donors. We conclude that the cytokine profiles induced by MDR E. coli in vitro were similar to those in susceptible strains. These findings suggest that the poor prognosis associated with MDR E. coli infections is not due to a differential immune response but rather to other factors.

Telemedicine Utilization Among Nurses in the UAE: Adoption, Training, and Infrastructure Readiness

Background: Telemedicine (TM) is a crucial component of modern health care, yet its adoption in nursing remains suboptimal. Effective integration requires structured training, institutional support, and digital infrastructure. Purpose: This study investigates TM utilization among nurses in the United Arab Emirates (UAE), focusing on its integration into practice, the training received, and the resources available to support its implementation. Methods: A cross-sectional survey was conducted among 434 nurses across hospitals and clinics in Dubai Health, UAE. The survey assessed demographic and professional details, TM experience, training availability, infrastructure, and institutional support. Data were analyzed using descriptive statistics and logistic regression. Results: While 70% of nurses reported TM availability, only 27% actively used it. Usage frequency varied, with 18% utilizing TM daily, 8% weekly, and 10% monthly. Adoption was highest in pediatric and geriatric care (50%) and lowest in intensive care units (11%). Remote patient monitoring and health education (47%) were the most common applications, whereas specialty consultations had the lowest use (17%). Logistic regression identified TM availability (OR = 2.1) and prior training (OR = 3.0) as key predictors of utilization (p < 0.001). However, only 14% of participating nurses had received formal TM training, though 90% expressed willingness to participate in future programs. Nurses' demographics, job titles, years of experience, and health sector did not significantly predict TM utilization (p > 0.05). Conclusion: TM has the potential to transform nursing practice, but its integration requires enhanced training programs, infrastructure investment, and institutional support. Addressing these gaps will optimize TM utilization and improve health care delivery.

Validation of the FASILA Score for Predicting Interventions and Outcomes in Traumatic Abdominal and Pelvic Injuries: A Prospective Clinical Study

BACKGROUND

The FASILA score is a 7-point scale comprising the FAST (focused assessment with sonography in trauma), shock index, and serum lactate. We aimed to validate this score prospectively in patients with abdominal and pelvic trauma to predict the need for massive blood transfusion, laparotomy, and inhospital mortality.

METHODS

This prospective study included all adult patients who sustained abdominal and/or pelvic trauma. Pediatric patients, prehospital cardiac arrest, and severe head injury were excluded. Data were analyzed and compared with low (< 4) versus high (≥ 4) FASILA scores.

RESULTS

A total of 400 patients (mean age 36.3 ± 12.7; 90% male; and 96% had blunt trauma) were enrolled between 2022 and 2024. Patients with higher FASILA scores (19.3%) had higher rates of exploratory laparotomy and radiological interventions and received more blood transfusions. They also had longer hospital stays, higher rates of sepsis, and mortality (p = 0.001). The FASILA scores significantly correlated with shock index (r = 0.75), ISS (r = 0.38), SOFA score (r = 0.36), and abdominal AIS (r = 0.27), TRISS (r = -0.19), RTS (r = -0.26), and fibrinogen levels (r = -0.12). A FASILA score ≥ 4 had a high specificity (85.5%) and negative predictive value (80%) for predicting the need for surgery. The FASILA score was an independent predictor of blood transfusion (odds ratio 1.92 and 95% CI 1.43-2.58) after adjusting for abdominal AIS, ISS, SOFA score, and fibrinogen level. AUROC curves were better for the FASILA score than ABC score and "SI alone" for the prediction of MTP and surgical interventions.

CONCLUSION

The significant association between high FASILA scores and blood transfusions, surgical interventions, and mortality indicates its usefulness in early risk stratification in abdominopelvic trauma. Multicenter studies are recommended to enhance external validity across diverse populations and settings.

Neutrophil to high-density lipoprotein cholesterol ratio as a potential inflammatory marker for predicting all-cause mortality in out-of-hospital cardiac arrest survivors

Out-of-hospital cardiac arrest (OHCA) survivors have more than one-third mortality rate. Numerous inflammatory indicators are available, and it should be feasible to identify a fast and accurate way to aid medical decisions. This retrospective cohort study included 247 patients with OHCA, hospitalized between January 2015 and August 2024. The study was conducted in the intensive care unit of China Medical University Hospital, Taichung, Taiwan. A variety of inflammatory markers, including interleukin-6, neutrophil to high-density lipoprotein cholesterol ratio (NHR), and C-reactive protein, were screened at 24 h after OHCA. The primary endpoint was the 90-day all-cause mortality. Receiver operating characteristic (ROC) curves and Kaplan-Meier survival curves of NHR were analyzed. Possible risk factors for all-cause mortality were estimated by Cox regression modeling. NHR and interleukin-6 were similarly predictive of all-cause mortality in inflammatory response, and both were superior to C-reactive protein at 24 h after OHCA (p < 0.001). The area under the ROC curve of NHR was 0.74 (95% confidence interval [CI]: 0.66-0.81, p < 0.001), sensitivity: 0.68, and specificity: 0.68, and NHR = 16.1. The 90-day all-cause mortality rate for NHR > 16.1 compared to those with NHR ≤ 16.1 was 0.51 and 0.21, respectively, according to Kaplan-Meier curves analysis. The hazard ratio for NHR > 16.1 was 2.54 (95% CI: 1.68-3.82, p < 0.001). An NHR > 16.1 at 24 h after OHCA is a potential inflammatory marker for predicting all-cause mortality.

Characterization of transferable antibiotic resistance plasmids in airborne particulate matter from ICU environments

Intensive care units (ICUs) are critical environments for the emergence of antibiotic-resistant bacteria, with numerous studies focusing on resistant pathogens in these settings. However, transferable antibiotic resistance plasmids (TARPs)-regardless of their origin from pathogenic or non-pathogenic bacteria-are key drivers of resistance gene dissemination and the emergence of resistant strains. This study investigated TARPs in ICU air. Air samples were directly used to isolate resistant plasmids using Escherichia coli CV601 as the recipient. Plasmid types, antibiotic resistance genes (ARGs), and virulence factors were identified through sequencing, and resistance phenotypes were validated. A total of 30 distinct plasmid types were detected, with IncX3 being the most prevalent. Among 245 ARGs identified, bla NDM-53, bla SHV-12, and BRP(MBL) were dominant. Phylogenetic analysis indicated that these TARPs originated from bacteria commonly colonizing human mucosa. ICU airborne TARPs may significantly contribute to the spread of ARGs and antibiotic resistance transmission.

The Cognitive Status Scale: A Preliminary Investigation of Psychometric Properties in a Clinically Referred Pediatric Critical Care Sample

BACKGROUND

Cognitive morbidities persist after pediatric critical care. However, a significant gap exists related to measuring cognitive outcomes in this patient population due to heterogeneity in presentations and objective measures. This study's purpose was to develop a psychometrically sound coding system to summarize clinically generated and performance-based neuropsychological outcomes to be used for research.

METHODS

The work was conducted in two stages: (1) Cognitive Status Scale (CSS) development and (2) a retrospective pilot test in a clinically referred sample of post-critical-care youth aged 6-19 years (N = 110) to explore preliminary psychometric properties of the CSS.

RESULTS

Principal components analysis supported the CSS structure (capturing 59% of the total explained variance). Internal consistency (α = 0.82) and interrater reliability (r = 0.92) were good. Within the full sample, criterion-related validity was demonstrated as the CSS total composite score from long-term evaluation and was significantly correlated with abbreviated performance-based cognitive outcomes from the acute recovery phase (Neurocognitive Index, r = 0.74). Divergent validity was shown via significant differences on the CSS total composite score between known clinical groups (≥ 3 Functional Status Scale [FFS] change = 30.23 vs. ≤ 2 FFS change = 50.94, t = 4.10, p ≤ 0.001, d = 0.91) and across CSS clinical indicators (F3,106 = 8.4495, p =  < 0.001, η2 = 0.194). Bivariate correlations showed a significant association in the expected direction between the CSS total composite score and the Functional Status Scale total score (r =  - 0.44, p ≤ 0.001), as well as a significant association in the expected direction between the CSS total composite score and the Behavior Rating Inventory of Executive Function, Second Edition General Executive Composite (r =  - 0.29, p = 0.010).

CONCLUSIONS

Primary evidence shows the CSS to be a reliable and valid measure for summarizing a clinically administered battery of cognitive assessments. Easy-to-generate metrics of performance-based cognition are essential to progress the state of the science germane to cognitive outcomes post pediatric critical care.

Synthesis, characterization and antimicrobial activity of functionalized amberlite polymer for biomedical application

A smart filter with antimicrobial activity is a promising membrane for detoxifying the blood. These toxins, such as creatinine and hippuric acid, were accumulated in the blood resulting from chronic kidney disease. A promising approach to detoxifying the blood involves modifying the surface of the material, designed to absorb toxins from blood components with great effectiveness. Here, the elimination of substances likes creatinine and hippuric acid from blood was investigated in relation to various functional groups in the polymeric adsorbent amberlite. The amino and sulfonate groups were added to the aromatic ring of the amberlite polymer (AM) independently to produce amberlite-NH2 (AM-NH2) and amberlite-SO3H (AM-SO3H), respectively. The modified polymer was defined using FT-IR, SEM, EDX, and elemental analysis (CHNS) techniques. The adsorption process factors were examined, and the resulting data were modeled using kinetic models, that encompassed pseudo-first-order and pseudo-second-order equations. The pseudo-second-order models provided the best fit to the experimental removal data. After fitting the equilibrium data to both the Freundlich and Langmuir equations, it was discovered that the Langmuir equation adequately captured the equilibrium data. AM-NH2 showed a 2.75 times improvement in the hippuric acid adsorption capacity rather than parent amberlite (AM), but AM-SO3H showed approximately 1.63 times increases in the blood toxin (hippuric acid) adsorption capability rather than the original amberlite. In the case of creatinine, the adsorption capacities were 130, 225.6, 385 mg g-1, for AM, AM-NH2, and AM-SO3H, respectively. According to the selectivity adsorption process, AM-NH2 demonstrated selectivity for hippuric acid, while AM-SO3H was more selective for creatinine. The antibacterial effects of all newly synthesized functional polymer materials on E. coli and S. aureus, along with their antifungal effects against A. niger, were examined. The newly synthesized polymers AM-NH2 and AM-SO3H exhibited significant antimicrobial activity, nearly equivalent to that of commercial antibiotics. The inhibition zones of newly synthesized polymers were recorded as 24 mm for E. coli, 25 mm for S. aureus, and 27 mm for A. niger. The Minimum Inhibitory Concentration (MIC) value of newly synthesized polymers was less than parent polymer. The current research will aid in the development of an antimicrobial filter base polymers, which provides a cost-effective and eco-friendly option for use in hemodialysis.

Veterinary Perspectives on Hemoglobin-Based Oxygen Carriers in Experimental Hemorrhagic Shock: Insights from Rabbit Models

Hemoglobin-based oxygen carriers (HBOCs) represent a promising alternative to traditional blood transfusions, offering the advantages of extended shelf life and avoiding blood compatibility limitations and infection risks. Positive effects of hemoglobin-based oxygen carriers (HBOCs) on hemorrhagic shock have been researched across various animal species, including swine, rats, rabbits, guinea pigs, and dogs. As previously described, HBOCs based on ovine hemoglobin display better efficiency in the context of hemorrhagic shock compared to those based on the more commonly used bovine hemoglobin. This was evidenced through higher survival rates and more favorable histopathological and immunological outcomes. The vascular effects of ovine hemoglobin polymerized with glutaraldehyde exposure included the absence of hypertension, minimal endothelial damage with slight alterations in inducible nitric oxide synthase (iNOS), and reduced vascular inflammation mediated by interleukin-10 (IL-10). Ovine hemoglobin has emerged as a particularly promising raw material for the development of HBOCs, surpassing bovine and human hemoglobin due to its advantages in availability and efficacy. Furthermore, reducing oxidative stress by polymerizing hemoglobin with glutaraldehyde is most effective with ovine hemoglobin compared to bovine hemoglobin. This study evaluates the effectiveness of ovine hemoglobin polymerized with glutaraldehyde in managing hemorrhagic shock in rabbits, with a focus on its ability to maintain blood pressure, support oxygen transport, and assess potential systemic and oxidative responses. Fifteen adult New Zealand white rabbits, divided into three equal groups, were included in this study: a negative control group transfused with colloid solutions, a positive control group treated with autotransfusion, and a group receiving HBOCs. All groups underwent a hemorrhagic shock protocol, with 40% of their total blood volume withdrawn under deep anesthesia, followed by transfusions 30 min later. Vital parameters, including invasive arterial blood pressure, heart rate, and end-tidal CO2, were measured throughout the experimental procedures. Arterial blood gas samples were collected before the procedures, after hemorrhagic shock induction, and at the conclusion of the transfusion. In summary, HBOCs offer a promising solution for oxygen delivery, but their effects on blood chemistry, particularly CO2 and lactate levels, must be considered. Although no direct oxygenation issues were observed in experimental models, elevated CO2 levels and the interference of HBOCs with lactate measurements emphasize the importance of vigilant clinical monitoring. Polymerized hemoglobin provides a non-nephrotoxic alternative, but challenges persist in preventing nitric oxide scavenging and ensuring effective oxygen delivery.

Characterisation of Mesenchymal Stromal Cells (MSCs) from Human Adult Thymus as a Potential Cell Source for Regenerative Medicine

Background: Mesenchymal stem cell-based therapy may be indicated in ischaemic heart disease. The use of autologous adipose-derived mesenchymal stromal cells (AdMSCs) offers regenerative potential due to their paracrine effects. The aim of this study was to expand and characterise adult human thymus-derived MSCs harvested during open heart surgery with respect to their stem cell and paracrine properties. Methods: Enzymatically and non-enzymatically isolated human thymic AdMSCs (ThyAdMSCs) were cultured in xeno-free media containing pooled human platelet lysate (pPL). MSC characterisation was performed. Ex vivo expanded ThyAdMSCs were differentiated into three lineages. Proliferative capacity and immunomodulatory properties were assessed by proliferation assays and mixed lymphocyte reaction, respectively. Gene expression analysis was performed by qPCR. Results: Both isolation methods yielded fibroblast-like cells with plastic adherence and high proliferation. Flow cytometry revealed distinct expression of MSC markers in the absence of haematopoietic cell surface markers. Ex vivo expanded ThyAdMSCs could be differentiated into adipocytes, osteocytes, and chondrocytes. Activated peripheral blood mononuclear cells were significantly reduced when co-cultured with ThyAdMSCs, indicating their ability to inhibit immune cells in vitro. Gene expression analysis showed significantly less IFNγ and TNFα, indicating an alteration of the activated and pro-inflammatory state in the presence of ThyAdMSCs. Conclusions: These results demonstrate an efficient method to generate AdMSCs from human thymus. These MSCs have a strong immunomodulatory capacity and are, therefore, a promising cell source for regenerative medicine. The culture conditions are crucial for cells to proliferate in culture. Further research could explore the use of ThyAdMSCs or their secretome in surgical procedures.

Outcomes of Sedative Hypnotic Agents Used for Endotracheal Intubation in Critically Ill Adults: A Systematic Review with Exploratory Meta-Analysis

ObjectiveSpecific sedative hypnotic agents, administered to facilitate endotracheal intubation (ETI) in critically ill adults, may lead to adverse outcomes such as peri-intubation cardiovascular collapse. However, little is known from systematic investigations of the impact these individual agents have on cardiovascular function or other clinical outcomes.Data sourcesMEDLINE, Embase, CENTRAL, ClinicalTrials.gov, Scopus and Web of science databases.Study selectionWe conducted a systematic search for randomized and non-randomized studies that evaluated adult (≥18 years) critically ill patients who were sedated to facilitate ETI with ketamine, propofol, ketamine/propofol, etomidate, or a benzodiazepine and who had data on peri-intubation hemodynamics and at least one other outcome involving acute kidney injury, delirium, opioid use, intubation difficulty, sequential organ failure assessment, length of stay, or mortality. Eighty-five studies were identified for eligibility assessment with 23 included in the analysis.Data extractionTwo reviewers independently screened articles, extracted data from selected articles, and assessed risk of bias using ROBINS-I for observational studies and revised Cochrane Risk of Bias tool for randomized controlled trials.Data synthesisAcute cardiovascular dysfunction (peri-intubation hemodynamic instability and/or cardiac arrest) was similar between etomidate and ketamine with more events seen when propofol versus non-propofol sedation was administered. However, exploratory meta-analysis demonstrated no difference between etomidate and ketamine (OR 1.05 [95%CI 0.60-1.84]) or between etomidate and propofol (OR 0.91 [95%CI 0.33-2.46]). Compared to ketamine, etomidate demonstrated lower survival to hospital discharge in the included studies in exploratory meta-analysis OR 0.76 (95%CI 0.62-0.92). Limited data existed for other outcomes with no discernible differences between sedative agents.ConclusionsAcute cardiovascular dysfunction was more common when propofol, as compared to non-propofol sedation, was administered, although not statistically significant in exploratory meta-analysis. In addition, etomidate conferred lower survival to hospital discharge versus non-etomidate sedation, which was confirmed in exploratory meta-analysis of etomidate versus ketamine.

Nurse-Initiated X-Ray Requests for Extremity Trauma in the Emergency Department: A Single-Center, Prospective, Before-and-After Cohort Study

BACKGROUND

Emergency department overcrowding and prolonged stays are critical issues in health care. Nurse-initiated X-ray requests for isolated extremity trauma may streamline patient care.

OBJECTIVE

This study aimed to assess the impact of nurse-initiated X-ray requests on patient care duration and overall management time in the emergency department.

METHODS

This single-center, prospective, before-and-after cohort study included 400 patients at the University Hospital of Orléans, France, between January and June 2023. During the first period, X-rays were ordered by physicians. In the second period, triage nurses, trained through a comprehensive program, were authorized to order X-rays. The primary outcome was the duration of medical management from initial physician contact to the end of care. Secondary outcomes included overall emergency department management time and additional X-rays ordered after evaluation.

RESULTS

Each period included 200 patients. The duration of medical care was significantly shorter in the second period (median, 21 minutes [interquartile rage, 9-56]) than the first period (median, 47 minutes [interquartile rage, 25-106]), with a median difference of -26 minutes (95% CI, -43 to -16; P<.001). The overall duration of patient management did not differ significantly between periods. Exploratory analyses suggested that a higher percentage of included patients on a given day correlated with shorter care durations for all attending patients.

CONCLUSION

The implementation of nurse-initiated X-ray requests was significantly associated with a reduction of approximately half an hour for patients with isolated limb trauma, although it did not affect the total duration of patient management. Further research is needed to evaluate the broader effectiveness of nurse-initiated X-ray requests in reducing emergency department management times.

Clinical and mechanistic relevance of high-dimensionality analysis of the paediatric sepsis immunome

Background

By employing a high-dimensionality approach, this study aims to identify mechanistically relevant cellular immune signatures that predict poor outcomes.

Methods

This prospective study recruited 39 children with sepsis admitted to the intensive care unit and 19 healthy age-matched children. Peripheral blood mononuclear cells were studied with mass cytometry. Unique cell subsets were identified in the paediatric sepsis immunome and depicted with t-distributed stochastic neighbour embedding (tSNE) plots. Network analysis was performed to quantify interactions between immune subsets. Enriched immune subsets were included in a model for distinguishing sepsis and validated by flow cytometry in an independent cohort.

Results

The median (interquartile range) age and paediatric sequential organ failure assessment (pSOFA) score in this cohort was 5.6(2.0, 11.3) years and 6.6 (IQR: 2.5, 10.1), respectively. High-dimensionality analyses of the immunome in sepsis revealed a loss of coordinated communication between immune subsets, particularly a loss of regulatory/inhibitory interaction between cell types, fewer interactions between cell subsets, and fewer negatively correlated edges than controls. Four independent immune subsets (CD45RA-CX3CR1+CTLA4+CD4+ T cells, CD45RA-17A+CD4+ T cells CD15+CD14+ monocytes, and Ki67+ B cells) were increased in sepsis and provide a predictive model for diagnosis with area under the receiver operating characteristic curve, AUC 0.90 (95% confidence interval, CI 0.82-0.98) in the discovery cohort and AUC 0.94 (95% CI 0.83-1.00) in the validation cohort.

Conclusion

The sepsis immunome is deranged with loss of regulatory/inhibitory interactions. Four immune subsets increased in sepsis could be used in a model for diagnosis and prediction of poor outcomes.

Personalized Nutrition Strategies for Patients in the Intensive Care Unit: A Narrative Review on the Future of Critical Care Nutrition

Introduction: Critically ill patients in intensive care units (ICUs) are at high risk of malnutrition, which can result in muscle atrophy, polyneuropathy, increased mortality, or prolonged hospitalizations with complications and higher costs during the recovery period. They often develop ICU-acquired weakness, exacerbated by sepsis, immobilization, and drug treatments, leading to rapid muscle mass loss and long-term complications. Studies indicate that adequate protein and calorie intake can decrease mortality and improve prognosis and recovery. However, optimal implementation remains a critical challenge. Objectives: This narrative review aims to summarize recent advances in nutritional strategies for critically ill patients. It highlights the benefits and limitations of current approaches including enteral (EN) and parenteral nutrition (PN) and examines their impact on clinical outcomes and overall mortality. Additionally, the review explores the emerging role of precision nutrition in critical care using technologies such as metabolomics and artificial intelligence (AI) to provide valuable insights into optimizing nutritional care in critically ill patients. Methods: A comprehensive literature search was conducted to identify recent studies, clinical guidelines, and expert consensus papers on nutritional support for ICU patients. The investigation focused on critical aspects such as the optimal timing for intervention, the route of administration, specific protein and energy targets, and technological innovations to support personalized nutrition, ensuring that each patient receives tailored support based on their unique needs. Results: Guidelines recommend initiating EN or PN nutrition within the first 48 h of admission, using indirect calorimetry (IC) to estimate energy needs, and supplementing protein up to 1.2 g/kg/day after stabilization. IC has gained importance in assessing energy needs but is still underused in the ICU. EN is preferred because it maintains intestinal integrity, reduces the risk of infections, and is recommended within the first 48 h of ICU admission. PN is used when EN is infeasible, but it increases the risk of infection. By integrating metabolomics with transcriptomic and genomic data, we can gain a deeper understanding of the effect of nutrition on cellular homeostasis, facilitating personalized treatments and enhancing the recovery of critically ill patients. Conclusions: AI is becoming increasingly important in monitoring and evaluating artificial nutrition, providing a more accurate and efficient alternative to traditional methods. AI can assist in identifying and managing malnutrition and is effective for estimating caloric and nutrient intake. AI minimizes human error, enables continuous monitoring, and integrates various data sources. The nutritional care of critically ill patients requires collaboration among specialists from diverse fields, including physicians, nutritionists, pharmacists, radiologists, IT experts, and policymakers.

Severe community-acquired pneumonia (sCAP): advances in management and future directions

Severe community-acquired pneumonia (sCAP) is a major global health challenge, with high morbidity and mortality, especially among patients requiring intensive care. Despite advancements in antimicrobial therapies and supportive care, sCAP remains a significant threat, particularly for those needing invasive mechanical ventilation or vasopressor support. Recent progress in diagnostics, therapeutics and management strategies offers hope for improved outcomes. Pathogen-specific management is now central to sCAP care, with molecular diagnostics enhancing pathogen detection accuracy and enabling tailored antimicrobial therapy. These tools help combat antimicrobial resistance by reducing unnecessary broad-spectrum antibiotic use.Host immune responses in sCAP vary widely and significantly impact outcomes. Some patients face an overwhelming pathogen burden, while others experience excessive immune responses, such as acute respiratory distress syndrome. This distinction is vital for guiding immunomodulatory therapies, as immunosuppression may benefit hyperinflammatory states but harm those overwhelmed by infection. Corticosteroids, though controversial, show potential benefits in select populations but carry risks like secondary infections and hyperglycaemia, requiring a nuanced approach.Non-invasive respiratory support strategies, such as high-flow nasal oxygen, have transformed care by improving oxygenation and reducing the need for invasive ventilation. However, their efficacy depends on timing, patient tolerance and disease severity, necessitating careful monitoring.Global disparities in sCAP management, particularly in low-income and middle-income countries, highlight the need for region-specific guidelines and scalable solutions. Limited access to advanced diagnostics and critical care resources exacerbates poor outcomes, underscoring the importance of investments in affordable diagnostics, infection control and multidisciplinary training. Emerging technologies, such as artificial intelligence and advanced imaging, promise to revolutionise sCAP management by enabling precision medicine and real-time insights into disease severity. A holistic, multidisciplinary approach integrating these advancements is essential to improving outcomes and advancing personalised care for this life-threatening condition.

Bacteremia in the Gulf Cooperation Council Region: A Review of the Literature 2013-2023

Bloodstream infections (BSIs) are amongst the leading healthcare-associated infections (HCAIs), and their comprehensive evaluation and management are of global and regional importance. This narrative review examines and reports data on BSIs from the Gulf Cooperation Council (GCC) region covering the period between 2013 and 2023. The reviewed literature demonstrated that BSIs were frequently associated with critical care settings such as the Intensive Care Unit (ICU) and were often associated with invasive lines and devices [such as central-line associated BSI (CLABSI)]. Fever was the main presenting symptom, while diabetes mellitus and hypertension were the common associated comorbidities. High mortality rates were reported for BSIs, particularly when caused by multidrug-resistant (MDR) Gram-negative pathogens. There was a wide range of antimicrobial resistance rates reported across the region; however, carbapenem-resistance rates exceeding 30% were reported for Pseudomonas aeruginosa, Acinetobacter baumannii and Klebsiella pneumoniae. Few publications included molecular mechanisms of carbapenem resistance; however, when mechanisms were reported they were dominated by OXA-48. In conclusion, the lack of structured surveillance programs and networks to monitor microbiological phenotypic and genotypic patterns as well as clinical outcomes across the region means there is paucity of uniform data on BSIs across the GCC region. To bridge this gap, we recommend timely surveillance programs for the monitoring of resistance and outcomes.

Extended Hematological Parameters and Short-Term Mortality in Sepsis Patients: A Retrospective Study

Background/Objectives: Sepsis has a high mortality rate, with septic shock exceeding 50%. The most common score for diagnosis and prognosis in sepsis is the Sepsis-related Organ Failure Assessment (SOFA). This study aimed to identify hematological parameters for the prediction of intensive care unit (ICU) mortality. Methods: This study collected demographic and clinical data from sepsis patients, including age, sex, infection site, length of stay, the SOFA, and ICU mortality. The standard laboratory panel included, among others, complete blood count with differential and reticulocyte panel. Intergroup differences were analyzed using Student's t-test, Mann-Whitney U test, Pearson's χ2, and Fisher's test where applicable. The AUROC was used for evaluating the predictive value of hematological parameters. Multiple logistic regression was performed to exclude the impact of potential confounding factors. Results: This study analyzed data from 190 sepsis patients hospitalized in the ICU, excluding patients with other conditions significantly affecting mortality. The median age was 65.0 (IQR 51.0-71.0) years. The sexes were almost perfectly balanced. The sites of infection were mostly the abdominal cavity, lungs, and urinary tract. The short-term mortality rate was 30%, with higher SOFA scores and significant differences in leukocyte, platelet, and erythrocyte parameters between survivors and non-survivors. The percentage of nucleated red blood cells (NRBCs) showed the highest AUROC. Conclusions: The only reliable hematological parameter for predicting ICU mortality in sepsis patients may be the percentage of NRBCs. The presence of NRBCs in a blood smear is linked to a worse prognosis.

Identifying the Influence of Lung-Related Injuries and Other Factors on Delirium in Traumatic Brain Injury Patients: A National Analysis

Traumatic brain injury (TBI) is a known risk factor for delirium, a condition associated with prolonged hospitalization and cognitive deterioration. Although the relationship between TBI and delirium is established, the influence of traumatic lung injuries on delirium development is less understood. Respiratory disorders can significantly influence the central nervous system, with sequelae such as hypoxia and hypercapnia causing neurologic dysfunction. Therefore, we hypothesized that TBI patients suffering lung-associated conditions, stemming either from traumatic lung injury (TLI) or subsequent pulmonary surgery will be associated with an increased risk of developing delirium.

METHODS

The 2021 Trauma Quality Improvement Program database was queried for patients with TBI, excluding those with pre-existing dementia. TBI patients developing delirium were compared to those without delirium. A multivariable logistic regression analysis was performed to determine pulmonary and neurogenic-associated risk factors for delirium.

RESULTS

Among 155,252 TBI patients, 3244 (2.1%) developed delirium. Delirium-afflicted patients showed elevated rates of TLI (25.0% vs 13.3%, p < .001), severe head trauma (51.4% vs 37.8%, p < .001), sepsis (3.1% vs 0.5%, p < .001) and more commonly underwent pulmonary operations (21.8% vs 6.6%, p < .001). The strongest associated risk factors for delirium included unplanned intubation (OR 2.79, CI 2.47-3.16, p < .001), pulmonary surgery (OR 1.47, CI 1.32-1.63, p < .001), COPD (OR 1.52, CI 1.34-1.72, p < .001), TLI (OR 1.25, CI 1.14-1.38, p < .001), and severe head injury (OR 1.12, CI 1.04-1.22, p = .003).

CONCLUSION

Delirium affects approximately 2% of the national TBI population. Our study reveals an influence of lung-related conditions for delirium onset. These results emphasize the intimate relationship of the brain and pulmonary system. Future prospective studies are needed to validate these findings as they may impact TBI management and outcomes.